Abstract：
BACKGROUND: Timely intensive care unit (ICU) admission for patients with encephalitis is associated with better prognosis. Therefore, our aim was to create a risk score predicting ICU admission in adults with encephalitis, which could aid in optimal management and resource allocation.
METHODS: We initially identified variables that would be most predictive of ICU admission among 372 patients with encephalitis from two hospital systems in Houston, Texas (cohort 1), who met the International Encephalitis Consortium (IEC) criteria from 2005 to 2023. Subsequently, we used a binary logistic regression model to create a risk score for ICU admission, which we then validated externally using a separate cohort of patients from two hospitals in Baltimore, Maryland (cohort 2), who met the IEC criteria from 2006 to 2022.
RESULTS: Of 634 patients with encephalitis, 255 (40%) were admitted to the ICU, including 45 of 113 (39.8%) patients with an autoimmune cause, 100 of 272 (36.7%) with an infectious cause, and 110 of 249 (44.1%) with an unknown cause (p = 0.225). After conducting a multivariate analysis in cohort 1, we found that the presence of focal neurological signs, new-onset seizure, a Full Outline of Unresponsiveness score ≤ 14, leukocytosis, and a history of chronic kidney disease at admission were associated with an increased risk of ICU admission. The resultant clinical score for predicting ICU admission had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% confidence interval [CI] 0.72-0.82, p < 0.001). Patients were classified into three risk categories for ICU admission: low risk (score 0, 12.5%), intermediate risk (scores 1-5, 49.5%), and high risk (scores 6-8, 87.5%). External validation in cohort 2 yielded an AUROC of 0.76 (95% CI 0.69-0.83, p < 0.001).
CONCLUSIONS: ICU admission is common in patients with encephalitis, regardless of etiology. Our risk score, encompassing neurologic and systemic factors, may aid physicians in decisions regarding intensity of care for adult patients with encephalitis upon hospital admission.
METHODS: We initially identified variables that would be most predictive of ICU admission among 372 patients with encephalitis from two hospital systems in Houston, Texas (cohort 1), who met the International Encephalitis Consortium (IEC) criteria from 2005 to 2023. Subsequently, we used a binary logistic regression model to create a risk score for ICU admission, which we then validated externally using a separate cohort of patients from two hospitals in Baltimore, Maryland (cohort 2), who met the IEC criteria from 2006 to 2022.
RESULTS: Of 634 patients with encephalitis, 255 (40%) were admitted to the ICU, including 45 of 113 (39.8%) patients with an autoimmune cause, 100 of 272 (36.7%) with an infectious cause, and 110 of 249 (44.1%) with an unknown cause (p = 0.225). After conducting a multivariate analysis in cohort 1, we found that the presence of focal neurological signs, new-onset seizure, a Full Outline of Unresponsiveness score ≤ 14, leukocytosis, and a history of chronic kidney disease at admission were associated with an increased risk of ICU admission. The resultant clinical score for predicting ICU admission had an area under the receiver operating characteristic curve (AUROC) of 0.77 (95% confidence interval [CI] 0.72-0.82, p < 0.001). Patients were classified into three risk categories for ICU admission: low risk (score 0, 12.5%), intermediate risk (scores 1-5, 49.5%), and high risk (scores 6-8, 87.5%). External validation in cohort 2 yielded an AUROC of 0.76 (95% CI 0.69-0.83, p < 0.001).
CONCLUSIONS: ICU admission is common in patients with encephalitis, regardless of etiology. Our risk score, encompassing neurologic and systemic factors, may aid physicians in decisions regarding intensity of care for adult patients with encephalitis upon hospital admission.
摘要：
背景：脑炎患者及时入住重症监护病房（ICU）与更好的预后相关。因此,我们的目的是创建一个风险评分，预测成人脑炎患者的ICU入院，这可以帮助优化管理和资源分配。
方法：我们最初在休斯顿两家医院系统的372名脑炎患者中确定了最能预测ICU入院的变量，德克萨斯州（队列1），2005年至2023年符合国际脑炎联盟（IEC）标准。随后，我们使用二元逻辑回归模型来创建ICU入院的风险评分，然后，我们使用来自巴尔的摩两家医院的独立患者队列进行了外部验证，马里兰州（队列2），从2006年到2022年符合IEC标准。
结果：在634例脑炎患者中，255人(40%)被送进重症监护病房,包括113例（39.8%）自身免疫性原因患者中的45例，272人中有100人(36.7%)有传染性原因，249人中的110人（44.1%），原因不明（p=0.225）。在队列1中进行多变量分析后，我们发现局灶性神经体征的存在，新发癫痫,无反应的完整轮廓评分≤14，白细胞增多，入院时的慢性肾脏病病史与ICU入院风险增加相关.预测ICU入院的结果临床评分的受试者工作特征曲线下面积（AUROC）为0.77（95％置信区间[CI]0.72-0.82，p<0.001）。患者被分为ICU入院的三个风险类别：低风险（评分0，12.5%），中等风险(得分1-5，49.5%)，高风险（6-8分，87.5%）。队列2的外部验证得出的AUROC为0.76（95％CI0.69-0.83，p<0.001）。
结论：脑炎患者入住ICU很常见，不管病因。我们的风险评分，包括神经和系统因素，可以帮助医生决定成人脑炎患者入院时的护理强度。
方法：我们最初在休斯顿两家医院系统的372名脑炎患者中确定了最能预测ICU入院的变量，德克萨斯州（队列1），2005年至2023年符合国际脑炎联盟（IEC）标准。随后，我们使用二元逻辑回归模型来创建ICU入院的风险评分，然后，我们使用来自巴尔的摩两家医院的独立患者队列进行了外部验证，马里兰州（队列2），从2006年到2022年符合IEC标准。
结果：在634例脑炎患者中，255人(40%)被送进重症监护病房,包括113例（39.8%）自身免疫性原因患者中的45例，272人中有100人(36.7%)有传染性原因，249人中的110人（44.1%），原因不明（p=0.225）。在队列1中进行多变量分析后，我们发现局灶性神经体征的存在，新发癫痫,无反应的完整轮廓评分≤14，白细胞增多，入院时的慢性肾脏病病史与ICU入院风险增加相关.预测ICU入院的结果临床评分的受试者工作特征曲线下面积（AUROC）为0.77（95％置信区间[CI]0.72-0.82，p<0.001）。患者被分为ICU入院的三个风险类别：低风险（评分0，12.5%），中等风险(得分1-5，49.5%)，高风险（6-8分，87.5%）。队列2的外部验证得出的AUROC为0.76（95％CI0.69-0.83，p<0.001）。
结论：脑炎患者入住ICU很常见，不管病因。我们的风险评分，包括神经和系统因素，可以帮助医生决定成人脑炎患者入院时的护理强度。
